中国实用外科杂志

中国实用外科杂志 ›› 2022, Vol. 42 ›› Issue (10): 1141-1146.DOI: 10.19538/j.cjps.issn1005-2208.2022.10.14

• 论著 • 上一篇    下一篇

全腹腔镜近端胃切除术中行裂隙法食管胃吻合可行性及疗效分析

洪    军，王雅平，王    健，华鲁纯，蒿汉坤   

  1. 复旦大学附属华山医院普外科，上海200040
  • 出版日期:2022-10-01 发布日期:2022-10-13

  • Online:2022-10-01 Published:2022-10-13

摘要： 目的    分析裂隙法食管胃吻合用于全腹腔镜近端胃切除术的可行性及疗效。方法    回顾性分析2021年11月至2022年3月复旦大学附属华山医院连续收治的4例行全腹腔镜近端胃切除术病例的临床资料，术中消化道重建均采用裂隙法食管胃吻合，即在完成近端胃切除后，于残胃前壁纵向做一浆肌层裂隙，长约3 cm，保留黏膜完整，将食管断端与裂隙远端胃壁行端侧吻合，吻合口近端的残胃作270°折叠包绕食管下端。观察病人术中情况、围手术期并发症以及术后恢复情况，术后随访10个月。结果    所有病例均于腔内完成吻合，无中转开放手术。手术时间为（225.5±48.8）min，吻合时间为（45.0±21.2）min，术中失血（30.0±16.3）mL。术后无Clavien-Dindo分级Ⅱ级及以上并发症发生。住院时间为（7.0±1.4）d。内镜随访未见明显吻合口狭窄或反流。结论    裂隙法食管胃吻合是一种安全可行的胃底折叠、瓣膜成形食管胃吻合方式，降低了手术难度，可在全腹腔镜下完成，可能有助于降低吻合口狭窄发生率。

关键词: 腹腔镜, 食管胃吻合, 近端胃切除术, 裂隙法, 腔内吻合, 反流性食管炎

Abstract: Feasibility and efficacy analysis of esophagogastric anastomosis by fissure technique in totally laparoscopic proximal gastrectomy        HONG Jun, WANG Ya-ping, WANG Jian, et al. Department of general surgery, Huashan hospital, Shanghai 200040, China
Corresponding author: HAO Han-kun, E-mail: haohankun@163.com
Abstract    Objective    To analyze the feasibility and the efficacy of the novel method of esophagogastrostomy by fissure technique for total laparoscopic proximal gastrectomy. Methods    Four consecutive cases who underwent esophagogastrostomy by fissure technique at Huashan Hospital between November 2021 and March 2022 were included in this study. The clinical data of the patients were retrospectively analyzed. Procedure steps: After the proximal gastrectomy, a 3-cm long seromuscular layer fissure was created longitudinally in the anterior wall of the remnant stomach, leaving the mucosa intact. An end-to-side anastomosis was performed between the esophageal stump and the low end of the gastric fissure. The proximal part of the remnant stomach was folded and wrapped around the lower part of the esophagus at 270 degrees. Data of intraoperative condition, postoperative morbidity, postoperative recovery, and follow-up endoscopic findings 3 months after the surgery were analyzed. Results    All cases were completed intracorporeally, and no one was converted to open surgery. The mean operation time was （225.5±48.8）mins, anastomotic duration was (45.0±21.2）mins， and operative blood loss was (30.0±16.3）mL. No postoperative complication above Clavien-Dindo grade Ⅱ occurred, and hospital stay was (7.0±1.4）d. All cases were followed up endoscopically 3 months after the surgery and no signs of anastomotic stenosis or reflux esophagitis were detected. Conclusion  Esophagogastrostomy by fissure technique is a safe and feasible approach to the esophagogastric anastomosis with fundoplication and valvuloplasty. It reduced surgical difficulty, which made it possible to be performed under totally laparoscopic surgery. Meanwhile, esophagogastrostomy by fissure technique may be potentially effective in reducing the incidence of anastomotic stenosis.

Key words: laparoscope, esophagogastrostomy, proximal gastrectomy, fissure technique, intracorporeal anastomosis, reflux esophagitis